ArticlePDF Available

Female Literacy, Fertility Decline and Life Expectancy in Kerala, India: An Analysis from Census of India 2011

Authors:

Abstract and Figures

The recent female literacy and fertility levels in Kerala state are examined using the 2011 census data. Arriaga’s approach for estimation of age-specific fertility rates is undertaken to show the particularities of Kerala state and the best practices which made this state an example for other states in India as well as other places in the world, particularly developing countries. Women’s empowerment gets as much credit as physical facilities and family planning programs; this empowerment level of women is also related to their level of education.
Content may be subject to copyright.
http://jas.sagepub.com/
Journal of Asian and African Studies
http://jas.sagepub.com/content/early/2014/07/11/0021909614541087
The online version of this article can be found at:
DOI: 10.1177/0021909614541087
published online 14 July 2014Journal of Asian and African Studies
A Sathiya Susuman, Siaka Lougue and Madhusudana Battala
from Census of India 2011
Female Literacy, Fertility Decline and Life Expectancy in Kerala, India: An Analysis
Published by:
http://www.sagepublications.com
can be found at:Journal of Asian and African StudiesAdditional services and information for
http://jas.sagepub.com/cgi/alertsEmail Alerts:
http://jas.sagepub.com/subscriptionsSubscriptions:
http://www.sagepub.com/journalsReprints.navReprints:
http://www.sagepub.com/journalsPermissions.navPermissions:
http://jas.sagepub.com/content/early/2014/07/11/0021909614541087.refs.htmlCitations:
What is This?
- Jul 14, 2014OnlineFirst Version of Record >>
by guest on July 15, 2014jas.sagepub.comDownloaded from by guest on July 15, 2014jas.sagepub.comDownloaded from
Journal of Asian and African Studies
1 –11
© The Author(s) 2014
Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/0021909614541087
jas.sagepub.com
J A A S
Female Literacy, Fertility
Decline and Life Expectancy in
Kerala, India: An Analysis from
Census of India 2011
A Sathiya Susuman
Department of Statistics and Population Studies, University of the Western Cape, South Africa
Siaka Lougue
Department of Statistics, University of Kuzulunatal, Durban, South Africa
Madhusudana Battala
Population Council, New Delhi, India
Abstract
The recent female literacy and fertility levels in Kerala state are examined using the 2011 census data.
Arriaga’s approach for estimation of age-specific fertility rates is undertaken to show the particularities of
Kerala state and the best practices which made this state an example for other states in India as well as
other places in the world, particularly developing countries. Women’s empowerment gets as much credit
as physical facilities and family planning programs; this empowerment level of women is also related to their
level of education.
Keywords
Female education, fertility decline, life expectancy, crude birth rate, female sterilization
Introduction
All the development indicators show that Kerala is an exceptional and exemplary state. The expec-
tations of planners and decision-makers in terms of fertility levels and female literacy in India have
been achieved in the state of Kerala. With a total fertility rate (TFR) of 1.58 and crude birth rate
(CBR) of 14.7, Kerala state is at below-replacement level of fertility (1.5 births per women)
(Census of India, 2011a).
Corresponding author:
A Sathiya Susuman, Department of Statistics and Population Studies, University of the Western Cape, Cape Town 7530,
South Africa.
Email: sappunni@uwc.ac.za
541087JAS0010.1177/0021909614541087Journal of Asian and African StudiesSusuman et al.
research-article2014
Original Article
by guest on July 15, 2014jas.sagepub.comDownloaded from
2 Journal of Asian and African Studies
The development model of Kerala is unique in the sense that the economic situation of the
state is similar to most developing countries, but its development indicators are comparable with
those of developed countries (Census of India, 2011b; Navaneetham and Dharmalingam, 2011).
It is therefore important to study which socio-cultural or developmental factors have contributed
significantly towards Kerala’s demographic transition and development success. This study tries
to innovate by examining the situation which works, instead of focusing on issues and
deficiencies.
The defining indicator for the impressive demographic performance of Kerala is accepted to be
the high levels of literacy, especially among women (Bhat and Rajan, 1990; Krishnan, 1976;
Zachariah, 1984; Zachariah and Rajan, 2001). Kerala’s infant mortality rate was one of the lowest
among the Indian states at the time the transition in fertility began. Kerala is one of the most
densely populated states in India (Chakraborty 2005; Office of the Registrar General, 1999b).
There are two types of information which can be used for estimating fertility from the census.
The first type relates to the information canvassed by the census on the births during the 12 months
preceding the census. In theory, this should provide a rather reliable estimate of birth rates during
the previous year, provided that births are properly reported (Guilmoto and Rajan, 2001, 2002,
2013). A more serious limitation of this source is that the so-called ‘fertility tables’ are published
rather late by the census, with direct estimates based on recent births not available for several years
(Indian Express, 2013). The second type of census variable available for indirect estimation pur-
poses is the child population distribution. The provisional population total figures have already
been published at the state level in 2011.
Analyses undertaken in this paper mainly examine the high level of female literacy (92%) with
fertility decline in Kerala during the 2011 census, and the continuous, but extremely fast-decreasing,
process of fertility, and life expectancy at birth, age-specific fertility rate (ASFR) and achieved
replacement-level fertility in India. In this paper, data are obtained from diverse sources and ana-
lyzed through simple frequency table, ratios and proportion estimations. Application of Arriaga’s
approaches for estimation of ASFR are also applied in this paper to measure the relationship
between fertility pattern by age at birth of child and fertility consistent with children ever born in
the states of India.
Data
Data from the Census of India 2011, Sample Registration System 2010 and diverse sources are
used in this study to show the particularities of Kerala state and the best practices which made this
state an example to others in India. Demographic sources at the state level remain, unfortunately,
limited. The quality of the vital registration system in India is still poor. The best population sources
for estimating state-level fertility in India—the Sample Registration System (SRS) and the National
Family and Health Survey (NFHS)—do not go below state level. There have been several district-
level demographic surveys such as the Reproductive and Child Health (RCH) survey and District
Level Household Survey (DLHS), but these sources do not cover India entirely, or do not provide
adequate fertility and female literacy measurements. The Census of India remains therefore the
only source for both simultaneous and exhaustive figures on fertility differentials at the state level.
The researchers’ intention is to use the very latest data source, which is the Census of India 2011.
Southern Indian states such as Tamil Nadu, Karnataka and Andhra Pradesh have achieved many
demographic developments, but Kerala state is exemplary. Kerala state’s female literacy rate
(94%), high female sterilization rate (78%) and below-replacement level of fertility (1.5 births per
women) are impressive. Therefore, the present study focuses on the exemplary female literacy,
fertility decline and life expectancy in Kerala.
by guest on July 15, 2014jas.sagepub.comDownloaded from
Susuman et al. 3
Methods
Graphical presentations have been adopted for female literacy and fertility rates. The data have
been analyzed through percentage distribution, ratios, proportion estimations and an estimation of
ASFR. The starting point was the sex ratio of 943 females per 1000 males in each state, as well as
infant and child mortality key indicators from SRS 2010. Also, the order in which the population
is growing in selected states with high female literacy, as well as the female literacy rate, is used to
compare the data between the years 1961–2011 in India. A comparison is also made between
female literacy rates and life expectancy at birth in India 2011. Furthermore, an application of
Arriaga’s approach for estimation of age-specific fertility rates for the study of ASFR based on the
2011 census data is used with MORTPAK4.
Arriaga’s approach for estimation of age-specific fertility rates
Fertility pattern of first enumeration: this indicates how the fertility pattern from the first enumera-
tion is tabulated, whether by age of mother at time of birth of the child or by age of mother at the
date of enumeration.
Children ever born (first enumeration period 2001, Kerala data used Census of India 2001): this
is the average number of children ever born per woman at the time of the first enumeration. Data
are given for age groups 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49.
Age-specific fertility pattern (first enumeration): this is the age-specific fertility pattern at the
time of the first enumeration. Data may be given as recorded ASFRs or as the proportionate age
distribution of fertility. Data are given for age groups 15–19, 20–24, 25–29, 30–34, 35–39, 40–44,
45–49.
Month of second enumeration: this indicates the month of the second enumeration, left blank if
data from only one enumeration are being entered.
Year of second enumeration (2011 Kerala state, Census of India 2011): the year of the second
enumeration. Left blank if data from only one enumeration are being entered. We adopted two sets
of census data, 2001 and 2011, matched with provisional total population (Census of India 2011).
We kept the 2011 census figure only.
Fertility pattern of second enumeration: this indicates how the fertility pattern from the second
enumeration is tabulated, whether by age of mother at time of birth of the child or by age of mother
at the date of enumeration.
Children ever born (second enumeration): this is the average number of children ever born per
woman at the time of the second enumeration. Data are given for age groups 15–19, 20–24, 25–29,
30–34, 35–39, 40–44, 45–49.
We used data from both enumerations if data not available; left blank if data from only one
enumeration are being entered.
Age-specific fertility pattern (second enumeration): this is the age-specific fertility pattern at the
time of the second enumeration. Data may be given as recorded ASFRS or as the proportionate age
distribution of fertility. Data are given for age groups 15–19, 20–24, 25–29, 30–34, 35–39, 40–44,
45–49.
Data can be given for one or two periods of time. If the year of the second census is blank or
zero, the procedure assumes that the second enumeration is not available. Therefore, any data
given for the second enumeration are not used. If data is available, it is best to enter it in order to
obtain a reliable output. It does not matter whether the fertility pattern is entered as ASFRs or as a
proportional distribution. The figures are adjusted by the multipliers to give identical results. In this
study, data on children ever born and recorded fertility rates in five-year age groups are available
by guest on July 15, 2014jas.sagepub.comDownloaded from
4 Journal of Asian and African Studies
from the Census of India 2001 and 2011. Arriaga’s approach is used to adjust the recorded ASFRs
to provide ‘corrected’ fertility estimates. The recorded ASFRs were tabulated by age of mother at
the time of the birth of the child. The results suggest that the recorded fertility underestimated
actual fertility by about 3%, and the true TFR is 1.66 births per woman.
Settings
The state of Kerala is found between the Arabian Sea to the west and the Western Ghats to the east.
It covers only 1.18% of India’s landmass. Kerala’s coast runs 580 km in length, while the state
itself varies from 35–120 km in width. Situated at the south-western tip of India, it has Tamil Nadu
and Karnataka as its neighboring states. Over the past century, Kerala’s population increased by
over five times from 6 million in 1901 to 33.4 million in 2011. Currently, it is the 12th most popu-
lous state, with slightly less than 3% population share. Its population compares with those of
Canada and Iraq, but is somewhat larger than the populations of Afghanistan, Nepal, and Malaysia.
Results
In the 2011 census, the population density of Kerala was 860 persons per km2, up from 819 in
2001, and only trailing Bihar (1106 up from 881) and West Bengal (1028 up from 903). The
national average is 382, up from 324 10 years ago. In the state, The highest density of 1508 persons
per km2 is reported from Thiruvananthapuram district, while Idukki with 255 has the lowest den-
sity. This high density has played a major role in improving access to essential social services such
as education and health care, thus leading to improved development indicators.
One of the most distinguishing features of Kerala is the female/male sex ratio: according to the
2011 census, Kerala has 1058 females per 1000 males against the national average of 933. Women
constitute 51.9 % of the total population of the state and outnumber men by 1.3 million. Here also
women outlive men. In the past 100 years, this has steadily improved. Even the most economically
advanced states such as Delhi, Punjab, Gujarat and Maharashtra do not match Kerala in female-
friendliness and empowerment of women (Census of India, 2011b). In the past decade, all districts
of Kerala have shown improvement in the sex ratio. As per the 2011 data, the top three districts are
Kannur (1133), Pathanamthitta (1129) and Kollam (1113), and even the bottom districts have better
figures—Idukki (1006), Ernakulam (1028), and Wayanad (1035)—than the national average.
A steadily aging population (13% people over 60 years compared with 8.2 nationally) and low
birth rate (14.8 per 1000 compared with national average of 22.1) make Kerala one of the few
regions of the developing world to have undergone the ‘demographic transition’. It is highest
among the major states of India. The highest per cent of elderly population is found in the Alappuzha
district. Kerala attained replacement-level fertility, or TFR of 2.1, during the early 1990s, and this
figure was 1.6 in 2011. Other states which achieved this feat in the following years are Andhra
Pradesh, Karnataka, Tamil Nadu, Maharashtra and Punjab.
Kerala has been setting an example of the potential of human development over the last several
decades. This state has emerged far ahead in human development indicators, leaving behind even
economically advanced states such as Gujarat and Maharashtra. It also has the lowest rate of popu-
lation growth, achieved without the coercive sterilization policies of the family planning ministry
(Office of the Registrar General, 1999b). Kerala has the lowest rural crude death rate (around 7.7
per thousand), lowest infant mortality (around 14 per 1000 live births), highest life expectancy at
birth (75 years), and highest literacy rate (94%). Its fertility rate is below sub-replacement level (at
around 1.7), and the infant mortality rate (only around 10 deaths per 1000 live births) is among the
best in the country.
by guest on July 15, 2014jas.sagepub.comDownloaded from
Susuman et al. 5
Growth rate of population in selected states
There has been a 5% fall in population growth rate in the state in each successive census since
1971. The decadal population growth rate was 25% growth rate in 1971, which reduced to 20% in
1981, 9.4% in 2001 and stands at 4.9% in 2011. If this trend continues, the growth rate in 2021 will
be either zero or negative. The birth rate among all the communities has been declining. At present
it is around 1.2 among Christians, as against 1.4 among Hindus and 2.1 among Muslims. The dif-
ference in the birth rate among different communities will be reflected in the overall state popula-
tion composition. It is expected that the Christian population should be about 16% in 2011, down
from 19.5% in 2001, and the Muslim community should be 25% as against 21% in 2001. In 2011,
the Hindu community should be around 54% against 56% in 2001. In looking at the top-level
female-literate states in India in 2011, according to the 2011 Population Census, about 90% of
female literacy is within the Kerala state of India.
Literacy and life expectancy
Kerala has a top-level female literacy rate at 94% (male literacy (96%) and female literacy (92%))
compared with the national average of 74% (male 82%, female 65.5%). In addition, Kerala has the
highest life expectancy (75.8 years; national average 65.5 years) in India. Children in the age group
0–6 years comprise just about 10%, and those up to 14 years comprise less than 25%, of the total
population, which is lowest among the major states of India. The falling number of children is
endangering primary schools; more and more schools are becoming uneconomical every year in
Kerala. The school dropout rate in the state is less than 0.5%, the lowest in the country.
The literacy rates are very varied from one state to another in India (Kerala=93.9%, Bihar=63.8%).
Figure 1 shows that these literacy rates are linked to life expectancy through the equation y=0.025x2
0.0093x+66.54 (R2=64%). This equation was obtained from the excel trend estimation of polyno-
mial regression. In fact, Figure 1 shows that a polynomial regression should fit well with the
present data. Figure 1 shows that life expectancy increases with literacy rate. In general, states with
a higher literacy rate have a higher life expectancy. In fact, the state of Bihar, with a literacy rate of
63.8%, has the lowest literacy rate in the country and also the lowest life expectancy. The state of
Kerala has the highest literacy rate (93.9%) and also the highest life expectancy level in the coun-
try. Figure 1 illustrates the link between the literacy rate and life expectancy in the country.
The TFR in India in general and Kerala in particular is estimated through indirect demographic
methods. The use of indirect estimate methods is the expression of the low quality of data, as in
several developing countries. Table 1 presents the result of Arriaga’s approach to determine the
fertility level in Kerala state. The use of MORTPACK4 software leads to a very similar estimate to
the census report 2011. In fact, Arriaga’s approach provides the estimate of TFR equal to 1.66. In
addition, the mean age at childbearing has been estimated to be 29.5 years. Finally, Table 1 high-
lights the important fact that of the highest rate of fertility is between 25–35 years.
Discussion
Sex ratio
The overall sex ratio at the national level has increased by 7 points since Census 2001 to reach 940
at Census 2011, but lacks the most exceptional features (a few to mention here are a high female
sterilization rate above 40% and 0% drop out from school) of the Kerala sex ratio. Coercive state
policies, such as the One Child Policy of China, combined with gender prejudice against women,
has led to a highly disturbed sex ratio creating several serious social issues. China already has a
by guest on July 15, 2014jas.sagepub.comDownloaded from
6 Journal of Asian and African Studies
surplus of over 30 million men under the age of 20 and adds about one million ‘extra male children’
each year. This scenario is loaded with potential for serious consequences in the future, and is
showing up in increasing sex-related crimes and trafficking of women from neighboring North
Korea and Myanmar (Sen 1990; Sen and Batliwala, 1997). Kerala has avoided all such side-effects
of societal distortions.
Crude birth rate and total fertility rate
Kerala state’s CBR and TFR are figures comparable with other countries. Some very low TFR
countries include Singapore (0.79), Taiwan (1.11), South Korea (1.24), Japan (1.39) and the EU as
a whole (1.58). The USA (2.07) is hovering just below the replacement value of 2.1. The world’s
average TFR is around 2.45 (down from 2.8 in 2002 and 5.0 in 1965). Kerala state’s TFR was 1.65
in 2011. Interestingly, this rate is similar to our analysis. However, several countries, especially
those in the developing world, have higher fertility rates than Kerala. To put things into perspec-
tive, here are some nations with a very high TFR: Niger (7.03), Mali (6.25), Somalia (6.17), Uganda
(6.06), Zambia (5.81), and Afghanistan (5.54). China reached the replacement fertility level around
the year 2000; it is expecting to see population stabilization by 2030. Population stabilization takes
place about 30–35 years after the replacement fertility has been reached; until then, the population
continues to grow due to momentum. It is hoped that by 2020 India’s TFR would have fallen to
replacement level. In India, the demographic transition has been relatively slow but steady. As a
result of Kerala state, India was able to avoid adverse effects of overly rapid changes in the number
and age structure of the population, as is seen in China which reduced the population by imposing
the one-child policy.
Figure 1. Life expectancy increases with the literacy rate in India 2011.
Source: Based on the census of India 2011 data estimated by authors.
by guest on July 15, 2014jas.sagepub.comDownloaded from
Susuman et al. 7
Table 1. Application of Arriaga’s approach for estimation of age-specific fertility rates from data on children ever born and the pattern of fertility at one or
two points in time in Kerala 2011, Census of India 2011.
Women’s age
group (years)
CEB ASFP Fertility consistent
with CEB (ASFR)
Fertility pattern
by age at birth
Cumulation of Age-specific fertility rates based on
adjustment factor for the age group
ASFR Fertility Pattern
by age at birth
Adjustment
factors
20–25 25–30 30–35
15–20 0.01 0.001 0.004 0.001 0.004 0.001 3.737 0.004 0.000 0.002
20–25 0.06 0.006 0.024 0.006 0.028 0.007 4.233 0.024 0.002 0.013
25–30 0.21 0.163 0.018 0.163 0.046 0.170 0.0270 0.691 0.044 0.368
30–35 0.20 0.098 –0.015 0.098 0.031 0.267 0.117 0.413 0.026 0.220
35–40 0.13 0.059 –0.009 0.059 0.023 0.0326 0.070 0.249 0.016 0.133
40–45 0.08 0.006 0.005 0.006 0.028 0.333 0.084 0.027 0.002 0.014
45–50 0.01 0.000 0.002 0.000 0.030 0.333 0.089 0.000 0.000 0.000
Mean age of childbearing: 29.53
Total fertility rate: 1.66
Source: Based on the Census of India 2011 data, estimated by authors used with MORTPAK4.
by guest on July 15, 2014jas.sagepub.comDownloaded from
8 Journal of Asian and African Studies
Infant mortality rate and fertility indicators
Kerala has been setting an example of the potential for human development over the last several
decades. As noted earlier, this state has emerged far ahead in human development indicators, leav-
ing behind even economically advanced states such as Gujarat and Maharashtra. It also has the
lowest rate of population growth, achieved without coercive sterilization policies of family plan-
ning (Ministry of Health and Family Welfare, 2000; International Institute for Population Sciences
and Macro International, National Family Health Survey 2005-2006, (IIPS, 2007)). Kerala has the
lowest crude death rate (around 7 per thousand), lowest infant mortality (around 14 per 1000 live
births), highest life expectancy at birth (75 years) and highest literacy rate (94%). Kerala attained
replacement level fertility, or TFR of 2.1, during the early 1990s. Other states which achieved this
feat in the following years are Andhra Pradesh, Karnataka, Tamil Nadu, Maharashtra and Punjab.
Literacy in Kerala
It is notable that Kerala achieved such a high literacy rate despite a sluggish growth in economy,
because normally economic growth has been known to curtail population growth. Sociologists
attribute these achievements to Kerala’s better healthcare, high literacy rate, and better standard of
living compared with other Indian states. Kerala’s human development indices—elimination of
poverty, primary level education, and healthcare—are among the best in India.
Top literacy states
Kerala has demonstrated that demographic transition, and hence population stabilization, can be
achieved through human development in general, and female literacy in particular. It proved many
Western thinkers wrong who believed that economic development alone can bring about demo-
graphic transition, as they had observed in their countries. It also highlighted that imposing a
smaller family size, as China has done, is not at all required to reduce population growth. Kerala
also highlights the role of gender equality and empowerment of women (IIPS, 2007; Radha et al.,
1996).
Literacy and life expectancy
The result of the analyses shows that when life expectancy is considered as an indicator of good
healthcare and development, there is a high correlation with literacy level. One can therefore state
that the high literacy rate in Kerala, especially among the female population, is the core driving
factor of Kerala’s success. In fact, Kerala’s healthcare system has garnered international acclaim,
with UNICEF and the World Health Organization designating Kerala the world’s first “baby-
friendly state”. For example, more than 95% births in Kerala are hospital delivered. The state also
cultivates several traditional forms of medical practices; apart from Ayurveda, Siddha, and Unani,
many endangered and endemic modes of traditional medicine, including Kalari, Marmachikitsa
and Vishavaidyam are practiced in Kerala (Radha et al., 1996). Furthermore, this study points to
high literacy as the most dominant factor leading to lower fertility. The study also points to a cor-
relation between education and fertility, as well as comparing the fertility parameters of Kerala and
Madhya Pradesh (Radha et al., 1996). The authors wondered why fertility is fairly high even among
women graduates in Madhya Pradesh and fairly low even among illiterates of Kerala. The authors
concluded that the spread of formal education among women cannot by itself bring about a drastic
change in their reproductive behavior. The present study shows that the state of Uttar Pradesh (200
by guest on July 15, 2014jas.sagepub.comDownloaded from
Susuman et al. 9
million) is the most populous state in the country, with a population greater than the population of
Brazil. In the future, the population of Uttar Pradesh and Maharashtra (312 million) will be greater
than that of the USA.
Age-specific fertility rate estimation
The mean age of childbearing women is 29 years, reflecting an improvement in the approach to
maternal health care. The study estimation of ASFR from data on children ever born and the pattern
of fertility proved that Kerala’s TFR is again declining. A supporting study argued that in the case
of Kerala, the high population density and the rather homogeneous spread of the population (with-
out the drastic village–town divide) has helped develop the infrastructure of schools and healthcare
facilities in such a way that they are easily accessible to the whole population (Zachariah, 1984).
In Kerala 95% of the population has been living in such settlement pattern. This pattern avoided
the lopsided development seen in other states, where facilities are concentrated in or around cities
and rural areas are left behind, both in facilities and with regards to easy access (Zachariah and
Rajan, 2001). In addition, the rather low or absent gender bias in Kerala should also be given credit.
When women are free of male dominance they are in a better position to control their fertility. This
empowerment must receive as much credit as other physical facilities and family planning pro-
grams. However, this empowerment level of women is also related to their level of education.
A negative point is that as the growth rate of the population continues to fall in Kerala over the
years, more schools have become ‘uneconomic’, a term used to describe schools which have insuf-
ficient numbers of children in them (Indian Express, 2013). Considered as a state where family
planning initiatives achieved the greatest success over the decades, Kerala had one of the country’s
lowest population growth rates of 4.9% in the last decade. Children in the age group of 0–6
accounted for a mere 10% of the state’s total population.
Conclusion
Kerala state has drawn the attention of all the other states in India regarding its impressive perfor-
mance in female literacy and drop in fertility rates. This achievement is an example for India and
many other countries around the world, especially low-income countries. Kerala state proposes a
unique model of success regarding population indicators, which needs a deep examination and a
close understanding to be replicated elsewhere. Kerala state has defeated the theory of demo-
graphic transition with level of fertility in a poor economic setting. From the analyses, it appears
that the Kerala model is a human development model which focuses on people and improving their
quality of life. This is totally opposite to what the West thinks and has prescribed: use people to
develop the economy and industry. This is flawed, as Nobel laureate Amartya Sen has often empha-
sized; the aim of development is to improve people’s quality of life, which depends upon many
things other than merely economic growth. These include freedom to participate in social and
political processes and activities, access to social support systems and health services, freedom
from insecurities, and so on. ‘Implications of Emerging Demographic Scenario’, based on an esti-
mation of Census of India 2011 data, suggests that India has been in the middle of the demographic
transition over the past several decades, where the death rate has fallen sharply because of improved
public health and sanitation almost everywhere in Indian states, but the birth rate has remained
high due to slow progress towards socio-economic development and limited access to quality
reproductive health and contraceptive services, especially in the four large north Indian States of
Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. This is the major cause of a spurt in popula-
tion as well as the stalled demographic transition, it warns. The Indian government should learn
by guest on July 15, 2014jas.sagepub.comDownloaded from
10 Journal of Asian and African Studies
from Kerala and shift the focus of family planning efforts to socio-cultural issues such as rising age
at marriage, women’s education, gender equality and empowerment of women.
Author note
*Revised version of the paper presented in the Future of Populations in Paris Conference, France. This con-
ference was organized in the frame of South African Seasons in France 2013 by INED (France) and the
University of the Western Cape (Department of Statistics & Population Studies).
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit
sectors.
References
Bhat PN and Irudaya Rajan S (1990) Demographic transition in Kerala revisited. Economic and Political
Weekly 25(35–36): 1957–1980.
Census of India (2011a) Provisional Population Totals, Paper 1 of 2011 India, Series-1. New Delhi: Office
of the Registrar General and Census Commissioner.
Census of India (2011b) Administrative Atlas of India. New Delhi: Office of the Registrar General and Census
Commissioner.
Chakraborty A (2005) Kerala’s Changing Development Narratives. Economic and Political Weekly February
5: 541–547.
Government of India Ministry of Home Affairs (2009) Sample Registration System Report 2008. New Delhi:
Ministry of Home Affair.
Gulimoto CZ and Irudaya Rajan S (2001) Spatial patterns of fertility change in Indian districts. Population
Development Review 27(4): 713–738.
Gulimoto CZ and Irudaya Rajan S (2002) District level estimates of fertility from India’s 2001 Census.
Economic and Political Weekly XXXVII(7): 665–672.
Guilmoto CZ and Irudaya Rajan S (2013) Fertility at district level in India: Lessons from the 2011 Census.
Working paper, Centre of Population & Development (CePed), June 2013. 30, Centre Population et
Développement, UMR 196 CEPED, Université Paris Descartes, INED, IRDhttp://www.ceped.org/wp.
Indian Express (2013) Kerala: Low birth rate turns more schools ‘uneconomic’ Thiruvananthapuram, Indian
Express March 17, 2013.
IIPS (2007) International Institute for Population Sciences (IIPS) and Macro International, National Family
Health Survey (NFHS-3), 2005–2006. Mumbai: IIPS.
Krishnan TN (1976) Demographic transition in Kerala: Facts and factors. Economic and Political Weekly
11(31–33): 1203–1224.
Ministry of Health and Family Welfare (MOHFW) (2000) National Population Policy, 2000. New Delhi:
Department of Family Welfare, MOHFW.
Navaneetham K and Dharmalingam A (2011) Demography and Development: Preliminary Interpretations of
the 2011 Census. Economic and Political Weekly X1VI(16): 13–16.
Office of the Registrar General (1999b) SRS Compendium of India’s Fertility and Mortality indicators, 1971–
1997 (Based on the Sample Registration System). New Delhi: Office of the Registrar General, India.
Radha Devi D, Rastogi SR and Retherford RD (1996) Unmet need for family planning in Uttar Pradesh,
National Family Health Survey Subject Reports No. 1. Mumbai: International Institute for Population
Sciences; and Honolulu: East-West Centre.
Sen AK (1990) Gender and Cooperative Conflicts. In: Irene Tinker (ed) Persistent Inequalities: Women and
World Development. New York: Oxford University Press.
Sen G and Batliwala S (1997) Empowering women for reproductive rights: Moving beyond Cairo, Paper
presented at: Seminar on Female Empowerment and Demographic Processes: Moving beyond Cairo.
IUSSP, Lund, Sweden, 21–24 April.
by guest on July 15, 2014jas.sagepub.comDownloaded from
Susuman et al. 11
Zachariah KC (1984) The anomaly of the fertility decline in India’s Kerala State: A field investigation. Staff
Working Paper No. 700. Washington DC: World Bank.
Zachariah KC and Irudaya Rajan S (2001) Gender dimensions of migration in Kerala: Macro and micro evi-
dences. Asia Pacific Population Journal 16(3): 47–70.
Author biographies
A Sathiya Susuman has an MA, MPhil in Population Studies and a PhD in Demography. He has specialized in
the social science research area of demographic analysis and reproductive health for 14 years. His specific
research area is fertility, mortality, empowerment of women, gender, reproductive health, health policy and
public health. He has published several articles in refereed journals. At present he is working at the Faculty of
Natural Sciences in the Department of Statistics and Population Studies, University of the Western Cape,
South Africa.
Siaka Logue has a PhD in Demography, and is working as Lecturer in Statistics at the Department of Statistics,
University of the Kwazulu Natal, South Africa.
Madhusudana Battala, PhD in Population Studies, is working as a Senior Research Officer in Population coun-
cil at New Delhi, India.
by guest on July 15, 2014jas.sagepub.comDownloaded from
... The majority of these foreign-born temporary workers are men from India, Bangladesh, and Pakistan, with one-or two-year visas, and the vast majority send remittances to their home communities. With its long history of Gulf migration, Kerala provides an ideal site for a study of migrant households; although given Kerala's exceptionally low fertility rate and high levels of literacy, caution should be exercised when extending these generalizations to other migrant-sending regions (Susuman, Lougue, & Battala, 2016). ...
... Many of the developmental gains in women's health and autonomy likely result from social changes already in place following past migration cycles. At 1.58, Kerala's total fertility rate is well below replacement level; female literacy is 92% (compared with a national average of 65%); contraceptive awareness is high; and infant mortality rates are the lowest in the country (Alukal, George, & Raveendran, 2018;Susuman et al., 2016). In these areas, any diffusion of normative change as a result of migration has already occurred; thus, we can rule out normative variation as a factor impacting women's autonomy today. ...
Article
Full-text available
The consequences for women “left behind” by virtue of temporary male migration are known to be mixed. On one hand, concomitant changes in fertility, female labor force participation, and social norms are often associated with increased independence for women. On the other hand, women left behind can be vulnerable to increased dependency on members of their husbands’ family, or face limited access to social institutions. These shifts in women's capacity for decision-making can have important implications for their health and well-being. Focusing on the state of Kerala in southern India, we examine the conditions under which the remittances that migrants send home have an impact on the health of women left behind. Specifically, we assess the extent to which the timing of remittance sending can support women's autonomy, and hence improve their autonomous healthcare decision-making and mobility to health facilities. We use evidence from migrant households in Kerala, a region deeply engrained in the world labor migration system for over five decades. Analysis is conducted with representative household survey data from the 2016 wave of the Kerala Migration Study (KMS), and paired with in-depth qualitative interviews with women in Kerala whose husbands and other family members have migrated to the Gulf. We show that the positive effect of remittances on women's autonomy manifests primarily through the timing of remittance receipt, not the amount of money remitted. Those who receive regular remittances experience more gains in autonomy, as compared to those receiving remittances at irregular intervals, net of amount remitted. This finding challenges the usual emphasis on remittance volume as the driving factor of social and behavioral change in sending communities. Analytical efforts should be refocused on the social-interactional component of remittance sending, and how these interactions can impact women's health and autonomy.
... Vijayakumar et al. (2016) analysed data from two census years, 2001 and 2011, and discovered the inverse relation between the female literacy, and IMR. Susuman et al. (2014) analysed 2011 census data and discovered that Kerala had the highest female literacy rate (92%) and the lowest IMR in India. used Sample Registration System (SRS) data of December 2016 to recognise the determinants of IMR in rural India and found, female education is a significant predictor of IMR. ...
Article
Full-text available
The study aims to understand the major determinants of infant mortality in infant mortality-prone annual health survey states of India. The study has considered district level infant mortality rate as a dependent variable and household size, sex ratio at birth, female literacy, marriage before the legal age, birth spacing, full antenatal care, Mothers who received post-natal care within 48 hours of delivery, Children within 12 to 23 months who are fully immunised, Breastfeeding within 24 hours of birth, Children aged 6 to 35 months are only breastfed for the initial 6 months, women who are aware of HAF/ ORS/ORT, and women who are aware of ARI/Pneumonia as independent variables. The study considered district-level data on the mentioned variables over nine annual health survey states over three years. The results reveal that female literacy, birth spacing, immunisation, only breastfeeding till 6 months, and awareness regarding HAF/ORS/ORT all have a statistically significant negative impact on IMR. On the other hand, post-natal care has a statistically significant positive impact on IMR. This surprising result can have two explanations. First, only those children receiving PNC who are already sick and succumbing to their sickness. Second, the patient death rate owing to hospital infection in India is very high, so it may be that infants are succumbing to this particular aspect. Identification of major determinants of infant mortality will eventually lead to actions against them, and that, in due course of time, will tame the onrush of infant mortality in Annual Health Survey States as well as other parts of India and the world. Quantification and determination of the major determinants of infant mortality for the annual health survey states are missing till date, and from that aspect, the article is novel.
... The proportion of older adults aged above 60 years varies from as high as 12.4 per cent in the state of Kerala to as low as 6.5 per cent in the populous Indian state of Uttar Pradesh (Chandramouli, 2011). The southern Indian state of Kerala has not only some of the most advanced development indicators among Indian states (Susuman et al., 2014) but also boasts of the largest number of emigrants working abroad (Varghese, 2011;Zachariah and Rajan, 2016). A typical emigrant from Kerala is from the young working-age range of 20-39 years and nearly 30 per cent of the primary emigrants were men who had left behind their wives and children, along with their parents (Rajan, 2014). ...
Article
Full-text available
The felt obligation to return a benefit, termed reciprocity , has been identified as motivating care exchanges between older adults and their younger family members. Within the context of large-scale emigration of young adults from the Indian state of Kerala, this study examines how left-behind older adults and their family care-givers recognise, interpret and give meaning to reciprocal exchanges, expectations and obligations in their care relationship. Employing a social exchange perspective, we qualitatively explore the norm of reciprocity through in-depth interviews of 48 participants (older adults and their care-givers) from emigrant households. Older adults and their care-givers identified reciprocal notions in their care exchange relationship that provided an interpretive framework for describing expectations, motivations, obligations and experiences across care-giving relationships. Spousal care-givers derived reciprocal motives and mutual care obligations through the institution of marriage. Adult children recognised filial duties and responsibilities and were in principle prepared to provide care to their parents. Reciprocating the support received and the likelihood of intergenerational transfers motivated care exchanges from adult children to their older parents. Daughters-in-law executed transferred filial roles from their emigrant husbands and bore a larger burden of care. Primary adult care-givers relied on the ‘demonstration effect’, hoping that children observe the care-giving process and emulate it later. Imbalances and non-reciprocity in the care exchange led to frustrations and threatened the care relationships.
... rate in India and this is attributed as one of the reasons for its better health indices. (13) But in spite of a high female literacy rate, the awareness on breast cancer is low as reported in studies done in the same district as well as other districts of the state. (12,14) A study conducted on a cohort of dental students in India also showed that the knowledge as well as their attitude towards BSE was poor indicating that higher educational status may not always be associated with increased knowledge. ...
... For example, the province of Misiones, Argentina, with policies for forest protection and sustaining local incomes, stands out by having very high, remotely-sensed values of NDVI (vegetation index) compared to the neighboring regions [Izquierdo et al., 2008]. The state of Kerala, India, despite a very low GDP per capita (under $300 until 1990s), through policies expanding access to education and medical care, enjoys higher life expectancy, lower birth rates, lower inequality, and superior education compared to the rest of India [Jeffrey, 1992;Singh, 2011;Susuman et al., 2016]. Formal primary, secondary, and tertiary education can also reduce societal inequalities and improve economic productivity [Sulston et al., 2012;Lutz et al., 2014;Cohen, 2008;Lutz and Samir, 2011]. ...
Article
Full-text available
Over the last two centuries, the impact of the Human System has grown dramatically, becoming strongly dominant within the Earth System in many different ways. Consumption, inequality, and population have increased extremely fast, especially since about 1950, threatening to overwhelm the many critical functions and ecosystems of the Earth System. Changes in the Earth System, in turn, have important feedback effects on the Human System, with costly and potentially serious consequences. However, current models do not incorporate these critical feedbacks. We argue that in order to understand the dynamics of either system, Earth System Models must be coupled with Human System Models through bidirectional couplings representing the positive, negative, and delayed feedbacks that exist in the real systems. In particular, key Human System variables, such as demographics, inequality, economic growth, and migration, are not coupled with the Earth System but are instead driven by exogenous estimates, such as United Nations population projections. This makes current models likely to miss important feedbacks in the real Earth–Human system, especially those that may result in unexpected or counterintuitive outcomes, and thus requiring different policy interventions from current models. The importance and imminence of sustainability challenges, the dominant role of the Human System in the Earth System, and the essential roles the Earth System plays for the Human System, all call for collaboration of natural scientists, social scientists, and engineers in multidisciplinary research and modeling to develop coupled Earth–Human system models for devising effective science-based policies and measures to benefit current and future generations.
... For example, Kerala state in India is the first largest state to have shown a notable fertility decline as a result of improvement in education, and this has attracted the attention of a number of researchers. Two factors stand out for Kerala: an early fall in mortality and a high level of education, including female education, both of which obviously favored fertility transition (Sathiya Susuman et al. 2014;UNDP 2010;World Health Organization 2010;Trussell 1975). However, in Tanzania, a mother's age at first birth indicates a higher mortality for infants born to older mothers. ...
Article
Full-text available
The Republic of Tanzania has been experiencing one of the highest infant and child mortality rates. There have been few efforts in understanding the bio-demographic factors associated with child loss. The 2011–2012 Tanzania HIV/AIDS and Malaria Indicator Survey is the third comprehensive survey on HIV/AIDS carried out in Tanzania. This study employed logistic regression ratios to estimate the effects of key bio-demographic variables on the outcome variable (child loss). Children who belonged to mothers with parity 4 to 8 and more than 9 had 1.27 and 1.08 times more risk of dying, respectively, compared to children in parity less than 3. Birth interval is one of the most important key factors to reduce child mortality. A birth spacing of 24 months or longer was observed in the successive birth interval of 76 % of the respondents. Special health care service fund allocation is essential to reduce child mortality in Tanzania. There is no doubt that the funding from international donor agencies and global partnerships will be important to the country's progress toward reducing infant, child, and maternal mortality.
Article
Full-text available
The study assesses the effect of inclusive education on health performance in 48 Sub Saharan African countries from 2000 to 2020. The study adopted the Driscoll/Kraay technique to address cross-sectional dependence and the GMM strategy to address potential endogeneity. The study employed three indicators of health performance which are the total life expectancy, the female life expectancy and the male life expectancy. Three gender parity index of educational enrolments are employed: primary education, secondary and the tertiary education as indicators of inclusive education. The findings of the study reveal that inclusive education enhances the health situation of individuals in Sub Saharan Africa. The findings further show that the health situation of both the male and the female are improved by inclusive education. The study recommends policymakers in this region to invest more in the education and the health sector so as to enhance the health performance of the citizens.
Article
Full-text available
Introduction Socioeconomic status (SES) is one of the important indicators affecting individual’s social participation and resource allocation, and it also plays an important role in the health shock of individuals. Faced by the trend of aging society, more and more nations across the world began to pay attention to prevent the risk of health shock of old adults. Methods Based on the data of China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015 and 2018, this study uses path analysis and ologit model to empirically estimate the effects of SES and health shock on the activities of daily living (ADL) disability of old adults. Results As a result, first, it was found that SES has significant impact on the disability of old adults. Specifically, economic conditions (income) plays dominant role. Economic status affects the risk of individual disability mainly through life security and health behavior. Secondly, SES significantly affecting health shock, with education and economic status showing remarkable impact, and there is an apparent group inequality. Furthermore, taking high education group as reference, the probability of good sight or hearing ability of the low education group was only 49.76% and 63.29% of the high education group, respectively, while the rates of no pain and severe illness were 155.50% and 54.69% of the high education group. At last, the estimation of path effect of SES on ADL disability indicates evident group inequality, with health shock plays critical mediating role. Conclusions SES is an important factor influencing residents’ health shock, and health shocks like cerebral thrombosis and cerebral hemorrhage will indirectly lead to the risk of individual ADL disability. Furthermore, among the multi-dimensional indicators of SES, individual income and education are predominant factors affecting health shock and ADL disability, while occupation of pre-retirement have little impact.
Article
Full-text available
The present paper describes the strategy to mitigate and control epidemic contingencies in the backdrop of Kerala’s Covid-19 containment plan. I have purposefully selected Kerala, the southernmost state of India, because of its globally acclaimed experience in efficiently managing the cases of coronavirus that were reported. Even tackling the Nipah and Zika virus cases in the pasts, makes it an exemplary unit of study. Moreover, the past experience of the state points to the fact that the containment strategy adopted is the result of an evolved practical approach. I came across certain innovative strategies implicating community mobilization like community kitchens, social surveillance, large scale production of face masks etc. by utilizing the hidden productive capacity of communities that extended from women self-help groups, youth clubs and even prison inmates. Moreover, the state’s controlling and containing measures were mentioned by international media and agencies like the BBC and the World Health Organization (WHO).
Article
Full-text available
The popular development narrative for Kerala suggests that the state's experience throws up issues that are expected to inform policy-makers elsewhere, in their endeavour to achieve human development goals within the constraints set by modest economic expansion. The positive tone of this narrative was somewhat subdued in the 1990s by the growing literature on the problem of 'sustainability', and the 'crisis' potential of the so-called Kerala model. The crisis narrative now seems to be giving way to an emerging one of economic growth that might have indirect links with the state's earlier achievements in education and health. In this paper, an attempt has been made to present Kerala's recent development experience in terms of a couple of identifiable narratives, instead of a singular 'fact'.
Article
Full-text available
The pace at which India’s population is growing is slowing, but not as rapidly as expected; India will become the largest country in the world sooner than earlier forecast. Literacy rates have increased sharply between 2001 and 2011; some of the low performing rates have shown strong improvements, the others have not. The dismal picture in the 2011 Census is that even as the overall sex ratio has improved due to better adult female mortality, that of the child sex ratio has further deteriorated. High mortality among girl children and sex selective abortions have pushed the child sex ratio down in all but three states.
Article
Full-text available
The article explores the dynamics of Indian fertility at the district level using a child-woman index developed from the four Indian censuses, 1961 to 1991. It employs statistical and geostatistical techniques to assess fertility change across districts and periods. Fertility decline is evident in every region, but sizable regional differentials exist. A cluster analysis of fertility profiles indicates that a clear spatial pattern of fertility in India has emerged and the pattern intensified because of the process of fertility decline. Copyright 2001 by The Population Council, Inc..
Article
Over the last few decades, both fertility and mortality rates have been falling, but the decline of mortality was strong enough to offset the fall in fertility rates. The 2001 Census, however, gives a clear indication that India is passing through the last phase of fertility transition, moving towards moderate to low fertility. Fertility declines have not, however, been uniform across the country and the differential rates are mainly responsible for the differentials in population growth rates across states and union territories.
SRS Compendium of India's Fertility and Mortality indicators, 1971-1997 (Based on the Sample Registration System)
Office of the Registrar General (1999b) SRS Compendium of India's Fertility and Mortality indicators, 1971-1997 (Based on the Sample Registration System). New Delhi: Office of the Registrar General, India.
Unmet need for family planning in Uttar Pradesh, National Family Health Survey Subject Reports No. 1. Mumbai: International Institute for Population Sciences
  • Radha Devi
  • Rastogi Sr
  • R D Retherford
Radha Devi D, Rastogi SR and Retherford RD (1996) Unmet need for family planning in Uttar Pradesh, National Family Health Survey Subject Reports No. 1. Mumbai: International Institute for Population Sciences; and Honolulu: East-West Centre.
Empowering women for reproductive rights: Moving beyond Cairo, Paper presented at: Seminar on Female Empowerment and Demographic Processes: Moving beyond Cairo
  • G Sen
  • S Batliwala
Sen G and Batliwala S (1997) Empowering women for reproductive rights: Moving beyond Cairo, Paper presented at: Seminar on Female Empowerment and Demographic Processes: Moving beyond Cairo. IUSSP, Lund, Sweden, 21-24 April.